ISO 21090 data types too complex?: HL7 models are created with clinician inp

Technical (archive)
1

They (the clinical models in HL7 v3 R-MIM format) are all part of extensive clinician input and review, sorry clinicians do understand the modeling in HL7 space, but indeed like any other modeling effort, need some education first.
Statements that this HL7 clinical content modeling is done without clinicians input is simply a lie.
Comments that clinicians are unable to read and understand and critique UML and/or HL7 RIM based class models is not consistent with my 8 year + experience with a dozen of national projects in the Netherlands.

There are several papers out there explaining how clinicians where involved and reviewing content and leading the input.

Bridging the HL7 template - 13606 archetype gap with detailed clinical models.Goossen WT, Goossen-Baremans A.Stud Health Technol Inform. 2010;160(Pt 2):932-6.PMID: 20841821 [PubMed - in process]Related citations

Sending electronic nursing discharge messages using the HL7 v3 Care Provision standard.Goossen W.Stud Health Technol Inform. 2009;146:269-75.PMID: 19592847 [PubMed - indexed for MEDLINE]Related citations

Using detailed clinical models to bridge the gap between clinicians and HIT.Goossen WT.Stud Health Technol Inform. 2008;141:3-10.

Using SNOMED CT codes for coding information in electronic health records for stroke patients.van der Kooij J, Goossen WT, Goossen-Baremans AT, de Jong-Fintelman M, van Beek L.Stud Health Technol Inform. 2006;124:815-23.PMID: 17108614 [PubMed - indexed for MEDLINE]Related citations

Evaluation of documents that integrate knowledge, terminology and information models.van der Kooij J, Goossen WT, Goossen-Baremans AT, Plaisier N.Stud Health Technol Inform. 2006;122:519-22.PMID: 17102312 [PubMed - indexed for MEDLINE]Related citations

Intelligent semantic interoperability: Integrating knowledge, terminology and information models to support stroke care.Goossen WT.Stud Health Technol Inform. 2006;122:435-9.

Development of a provisional domain model for the nursing process for use within the Health Level 7 reference information model.Goossen WT, Ozbolt JG, Coenen A, Park HA, Mead C, Ehnfors M, Marin HF.J Am Med Inform Assoc. 2004 May-Jun;11(3):186-94. Epub 2004 Feb 5.PMID: 14764610 [PubMed - indexed for MEDLINE]Free PMC ArticleFree textRelated citations

Electronic patient records: domain message information model perinatology.Goossen WT, Jonker MJ, Heitmann KU, Jongeneel-de Haas IC, de Jong T, van der Slikke JW, Kabbes BL.Int J Med Inform. 2003 Jul;70(2-3):265-76.

Modeling nursing care in health level 7 reference information model.Helleman J, Goossen WT.Comput Inform Nurs. 2003 Jan-Feb;21(1):37-45.

Electronic patient records: Dutch domain information model perinatology.Goossen WT, Jonker M, Kabbes BL.Stud Health Technol Inform. 2002;90:366-70.

Model once, use multiple times: reusing HL7 domain models from one domain to the other.Goossen W.Stud Health Technol Inform. 2004;107(Pt 1):366-70.
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2

William,

I don’t think anyone said there were no clinical people involved in HL7v3 modelling. However it is certainly a widely available experience all over the world that many clinicians engaged in content modelling for some programme or standards reason find it difficult to use UML. This is not because of UML being difficult per se (although most people who claim to understand it do not have any understanding of the downstream consequences of modelling choices made in the diagrams), but because a) UML is mal-adapted to what they want to express (using a class language to express an object constraint structure is annoying) and b) they tend mostly to think in terms of screens, their normal visualisation of the data and/or workflow. Nevertheless, there are undoubtedly some clinicians who can understand some UML diagrams. This is not evidence that all clinicians working in this area can author the correct UML diagrams (even assuming that to be possible).

RIM-based models are famously incomprehensible to people from all walks of life. Again, there are some people (including some clinicians) who understand them, and can author them, but they are a) not very intuitive and b) highly complex, for realistic examples. Due to the lack of basic data structures, e.g. the example of History/Events structure used in openEHR, such structures are avoided, or have to be manually created from Act / ActRelationship networks. The huge number of attribute nodes and code values also causes complications; I once calculated the value space of a single Act node with its 22 attributes to be 810 billion points. You can guess that the possible value space of a realistic RMIM is astronomical. This makes building models difficult. The traffic on the HL7 MnM list indicates the massive ongoing confusion around these models for a decade. If you don’t believe me, try searching your archive simply for posts relating to ‘context conduction’. If this modelling method were easy, everyone would be using it.

  • thomas
3

Hi William

I didn’t see anyone say that the hl7 models have been developed without clinical input. I am certain this isn’t true.

I don’t completely agree with you about the ease of accessibility for clinicians of UML models and MIF models - it’s not our experience.

Regards Hugh